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Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2021 Mar; Vol. 73 (3), pp. 826-835. Date of Electronic Publication: 2020 Jul 03. - Publication Year :
- 2021
-
Abstract
- Objective: Previous publications have clearly established a correlation between timing of thoracic endovascular aortic repair (TEVAR) and complications after treatment of complicated acute type B aortic dissection (ATBAD). However, the temporal association of TEVAR with morbidity after uncomplicated presentations is poorly understood and has not previously been examined using real-world national data. Therefore, the objective of this analysis was to determine whether TEVAR timing of uncomplicated ATBAD (UATBAD) is associated with postoperative complications.<br />Methods: The Vascular Quality Initiative TEVAR and complex endovascular aneurysm repair registry was analyzed from 2010 to 2019. Procedures performed for non-dissection-related disease as well as for ATBAD with malperfusion or rupture were excluded. Because of inherent differences between timing cohorts, propensity score matching was performed to ensure like comparisons. Univariate and multivariable analysis after matching was used to determine differences between timing groups (symptom onset to TEVAR: acute, 1-14 days; subacute, 15-90 days) for postoperative mortality, in-hospital complications, and reintervention.<br />Results: A total of 688 cases meeting inclusion criteria were identified. After matching 187 patients in each of the 1- to 14-day and 15- to 90-day treatment groups, there were no statistically significant differences between groups. On univariate analysis, the 1- to 14-day treatment group had a higher proportion of cases requiring reintervention within 30 days (15.3%) compared with UATBAD patients undergoing TEVAR within 15 to 90 days (5.2%; P = .02). There was also a difference (P = .007) at 1 year, with 33.8% of the 1- to 14-day UATBAD patients undergoing reintervention compared with 14.5% for the 15- to 90-day group. There were no statistically significant differences on multivariable analysis for long-term survival, complications, or long-term reintervention. There was a trend toward significance (P = .08) with the 1- to 14-day group having 2.3 times the odds of requiring an in-hospital reintervention compared with the 15- to 90-day group.<br />Conclusions: Timing of TEVAR for UATBAD does not appear to predict mortality or postoperative complications. However, there is a strong association between repair within 1 to 14 days and higher risk of reintervention. This may in part be related to the 1- to 14-day group's representing an inherently higher anatomic or physiologic risk population that cannot be entirely accounted for with propensity analysis. The role of optimal timing to intervention should be incorporated into future study design of TEVAR trials for UATBAD.<br /> (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Disease
Aged
Aortic Dissection diagnostic imaging
Aortic Dissection mortality
Aortic Aneurysm, Thoracic diagnostic imaging
Aortic Aneurysm, Thoracic mortality
Blood Vessel Prosthesis Implantation mortality
Endovascular Procedures mortality
Female
Humans
Male
Middle Aged
Postoperative Cognitive Complications diagnostic imaging
Postoperative Cognitive Complications mortality
Postoperative Cognitive Complications therapy
Registries
Retreatment
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Aortic Dissection surgery
Aortic Aneurysm, Thoracic surgery
Blood Vessel Prosthesis Implantation adverse effects
Endovascular Procedures adverse effects
Postoperative Cognitive Complications etiology
Time-to-Treatment
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 73
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32623110
- Full Text :
- https://doi.org/10.1016/j.jvs.2020.05.073